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The objective behind any health reform should be bet -ter quality, efficiency and sustainability of health care. Reform of the system is needed to achieve this. One important aspect of the reform is greater autonomy to the major teaching hospitals, including selected district hospitals. There should be a major effort to agree what
is the intention behind autonomy and exactly what is expected to be passed to the control of the major hos -pitals in terms of autonomy for management decisions, financial procedures and performance, planning and development, human resource management and clin -ical performance 1. The principle of decisions made at the lowest level practical should prevail. This means that autonomy and decentralization should also be passed down within hospitals to departmental levels 2. Needless to mention that success of any reform agenda to be implemented rests on the agreement and full backing of the majority of the stakeholders
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